Wednesday, August 1, 2007
Unfortunately, this is not the title of a recent episode of Law and Order but I true story concerning charges brought against a surgeon for allegedly hastening the death of several patients.
San Luis Obispo County prosecutors charged a San Francisco transplant surgeon with three felonies Monday, alleging he attempted to hasten the death of a 26-year-old disabled man last year at Sierra Vista Regional Medical Center in an attempt to harvest his organs.
Prosecutors are charging Dr. Hootan Roozrokh, 33, with dependent adult abuse, administering a harmful substance, Betadine, and unlawful prescribing of sedatives to a severely disabled man, Ruben Navarro. If convicted of all charges he could face up to eight years in prison. . . .
The local case is the first of its kind against a transplant surgeon and has vast implications for the nation's organ donor system because it casts doubts on organ donation after cardiac death, or heart failure. That's less common than donation after brain death, but increasingly seen as a way to help alleviate the national organ shortage. In 2006, for example, organs were recovered from 645 donors nationwide after cardiac death, representing 8 percent of all deceased donors. That's up from 189 in 2002.
Prosecutors allege that Roozrokh violated the law on Feb. 3, 2006, when he took control of Navarro's care before he was dead, and that he mistreated him by ordering excessive amounts of sedatives "to accelerate Mr. Navarro's death in order to recover his organs," a statement said. Navarro's organs were not harvested because he did not die within 30 minutes — the timeframe under which his organs remained viable for transplant.
"The central issue of the case is the mistreatment of a person who was still alive," said Stephen Brown, chief deputy district attorney. . . . .
Donation after cardiac death is more complex and controversial than donation after brain death, when the patient has already been declared legally dead before being removed from breathing machines. In the former situation, once a patient is removed from machines and declared dead due to heart failure, there is only a five-minute interval to observe death before surgeons begin recovering organs.
Cardiac death donations fall within ethical guidelines if strict protocols are followed. The medical community's paramount rules and state law say that transplant surgeons should have no contact with the patient until the attending physician declares death and any attempts to hasten death are prohibited. An alleged breach of those protocols led to the charges against Roozrokh.
Navarro was taken by ambulance to Sierra Vista on Jan. 29, 2006, after he was found in a coma at the residential care home where he lived in San Luis Obispo. The patient, who at 10 was diagnosed with a rare degenerative disease, was placed on life support, but not declared brain dead because he had minimal brain function. Navarro's mother then agreed to donate his organs, according to a police investigation.
The Oakland, Calif.-based Organ Transplant Donor Network dispatched a surgical team, which included Roozrokh, from San Francisco to recover Navarro's organs. Navarro was taken into the operating room and removed from life support, but he did not die within 30 minutes.
Violating the hospital's protocol and state law, Roozrokh took over caring for Navarro before he was declared dead and ordered a nurse to give Navarro abnormally high doses of morphine and Ativan to hasten death, according to an investigation by the U.S. Centers for Medicare and Medicaid Services. Prosecutors also allege that Roozrokh injected Betadine, a topical antiseptic, into Navarro's stomach. The attempted organ donation occurred on a Friday night. Navarro died the next day at 8 a.m. Operating room nursing staff alerted hospital administrators the following Monday about the incident. The hospital then notified police and state and federal health officials.
None of the other six nurses, doctors and technicians who were in the operating room and did not intervene will face criminal charges, Brown said.
San Luis Obispo police turned the case over to the county District Attorney's Office in March. The rare circumstances and the fact that there is no case precedent slowed the investigation, prosecutor Brown said. "Dr. Roozrokh and his wife have suffered immeasurably as a result of the dissemination of false accusations and the interminable delay in the investigation of this case," according to the statement from his attorney. . . .